The objective of this study was to investigate, for the first time, the seroprevalence of cryptosporidiosis among urban and rural inhabitants in several departments of the Andean region of Colombia. The antigen recognition of Cryptosporidium parvum was also studied with sera. Between June 1996 and October 1998 1 778 serum samples were collected from people selected through convenience sampling. The detection of anti-C. parvum antibodies (IgM, IgA, and IgG) was carried out with enzyme-linked immunosorbent assay, and antigen recognition was done with immunoblotting. A prevalence of 83.3% was found, and the antibody percentages were 72.2% for IgM, 27.7% for IgA, and 27.6% for IgG. Higher seropositivity percentages were found among women, persons less than 30 years old, and residents of rural areas. IgM seroprevalence decreased with age, while IgG and IgA seroprevalences increased with age. These three immunoglobulin isotypes most frequently recognized the antigens from 51 to 69 kDa, which can be considered immunodominant. Of note was the immunoreactivity of IgM and IgA to protein fractions from 12 to 14 kDa and from 42 to 48 kDa, respectively, which could indicate exposure to the parasite. These results indicate that cryptosporidiosis is endemic in the Andean region of Colombia, and that it is possible to attribute many cases of diarrheal syndrome to C. parvum.

Nutritional status of children under 5 years of age in three hurricane-affected areas of Honduras Articles

Hurricanes and other natural disasters can produce crop destruction, population displacement, infrastructure damage, and long-term public health consequences that include increased malnutrition among the affected populations. This paper presents the results of anthropometric measurements taken of 295 children under 5 years of age from three regions of Honduras that were affected by Hurricane Mitch, a major storm that struck Central America in the fall of 1998. The children in our study were sampled in three shelters in the capital city of Tegucigalpa; in the resettlement zone of Nueva Choluteca, Choluteca; and in the small urban area of Catacamas, Olancho. Our data indicated that, in comparison to the period before the hurricane, there was an elevated prevalence of wasting in all three of the study areas, and that there were also high levels of underweight in the Tegucigalpa and Nueva Choluteca study areas. There were statistically significant differences between the mean values of malnutrition indicators for Catacamas and those for the Tegucigalpa and Nueva Choluteca settlements. These differences suggest that resettled families were confronting a nutritional crisis in July and August of 1999, some 9 months after the hurricane struck.

Evaluation of the effectiveness of a new vaccine against human leptospirosis among groups at risk Artículos

In order to evaluate the effectiveness of a new vaccine against human leptospirosis, a prospective cohort study was done with persons in the Cuban province of Holguín who were at risk of becoming ill with leptospirosis. The study included 118 018 persons from 15 to 65 years old who were considered to face either permanent or temporary risk. The vaccinated cohort consisted of 101 137 persons. They received two vaccine doses, 6 weeks apart, of 0.50 mL via deep intramuscular injection into the deltoid muscle of the nondominant arm. The unvaccinated cohort consisted of 16 881 persons. Epidemiological surveillance began 21 days after the application of the second vaccine dose and continued for 1 year. The same criteria for suspected and confirmed cases were maintained throughout the study period. At the end of the surveillance period effectiveness was calculated as being higher than 97%. It is estimated that the vaccination program prevented eight out of ten cases that would have otherwise occurred. Vaccine reactogenicity was also measured in a subsample of 1 500 persons between 15 and 65 years old. The observed symptomatology was low. Slight pain at the injection site was the most frequent symptom (25%). The results of the study indicate the usefulness of the vaccine for disease prevention among people at risk, and its use is thus recommended.

History, effects, and mechanisms of action of ecstasy (3,4-methylenedioxymethamphetamine): a literature review

This review focuses on 3,4-methylenedioxymethamphetamine, an illegal drug known as "ecstasy." Ecstasy was introduced in Brazil in 1994. Data are lacking on the epidemiology and usage pattern of the drug in Brazil. However, there is evidence that until now the use of ecstasy has been limited to middle-class or upper-middle-class youth, so that most people, including health care professionals, are unfamiliar with the drug. However, ecstasy may be becoming more popular in Brazil, following a pattern seen in North America and Europe. Possibly contributing to the drug's popularity is the fact that ecstasy is sold as a pill and is thus extremely easy to use. Ecstasy has a reputation for not being physically dangerous; however, there are many reports of adverse reactions associated with the drug. In addition, it is known that not all pills sold as ecstasy actually contain methylenedioxymethamphetamine. Since there is no quality control for the pills' contents, users never know exactly what they are taking. Thus, although users may perceive the effects of the drug as mostly positive, ecstasy is potentially dangerous. Primary and secondary interventions are needed to prevent the use of ecstasy and the occurrence of adverse reactions. To be effective, these measures must take into consideration the characteristics of the user population and the usage patterns. It is also essential to prepare health professionals for emergency medical interventions in cases of intoxication and complications resulting from the use of ecstasy.

The use of socioeconomic factors in mapping tuberculosis risk areas in a city of northeastern Brazil Articles

In Brazil the challenge of meeting the needs of those living in deprived areas has generated discussions on replacing the existing approach to epidemiological surveillance with an integrated public health surveillance system. This new approach would supplant the traditional focus on high-risk individuals with a method for identifying high-risk populations and the areas where these persons live. Given the magnitude of the problem that tuberculosis (TB) poses for Brazil, we chose that disease as an example of how such a new, integrated public health surveillance system could be constructed. We integrated data from several sources with geographic information to create an indicator of tuberculosis risk for Olinda, a city in the Brazilian state of Pernambuco. In order to stratify the urban space in Olinda and to check for an association between the resulting TB risk gradient and the mean incidence of the disease between 1991 and 1996, we applied two different methods: 1) a "social deprivation index" and 2) principal component analysis followed by cluster analysis. Our results showed an association between social deprivation and the occurrence of TB. The results also highlighted priority groups and areas requiring intervention. We recommend follow-up that would include treating acid-fast bacilli smear-positive pulmonary TB cases, tracing of these persons' contacts, and monitoring of multidrug-resistant cases, all in coordination with local health services.

We standardized a solid-phase enzyme-linked immunosorbent assay (ELISA) in order to study the presence of Trypanosoma cruzi antibodies in asymptomatic persons who live in an area of Nicaragua endemic for Chagas' disease. The test was standardized to analyze filter-paper blood samples, which are easy to transport. In the first phase of our investigation, ELISA was used to study 18 samples of total serum and 18 eluates of blood from patients with chronic Chagas' disease; 30 samples of serum and 30 eluates of blood from healthy people, used as negative controls; and 14 samples of serum and 14 eluates of blood from patients with cutaneous or visceral leishmaniasis, which were used to study cross-reactions. Both with the total-serum and the blood-eluate samples, the ELISA test provided 100% sensitivity and 90% specificity. Cross-reactions in the patient samples were observed only with visceral leishmaniasis. The second phase of our investigation was a population study that included eight rural communities in the area of Somoto, Nicaragua. Through random sampling, filter-paper blood samples were collected from 2 434 people (1 335 men and 1 099 women) from the communities of Aguas Calientes, El Brocal, La Manzana, Las Playas, Los Canales, Santa Isabel, Santa Rosa, and Santa Teresa. Studied by ELISA and by indirect immunofluorescence (IIF), the samples included 260 found seropositive by ELISA (10.7%), of which 207 were positive according to IIF (8.5%). With both techniques, the majority of seropositives were among women, but the difference between men and women was not statistically significant. There was a high level of agreement between the results obtained with the two techniques. There was an upward trend with age, with 5.4% of those found seropositive by ELISA being persons 10 years of age or younger and 42.7% of those found seropositive being older than 50. The vast majority of the individuals analyzed were asymptomatic.

Estado deplorable de la higiene en el mundo Instantáneas

HIV and AIDS in the Americas: an epidemic with many faces Temas de Actualidad

This document presents data that was analyzed at a joint meeting of the Monitoring the AIDS Pandemic Network and the Latin America and Caribbean Epidemiological Network for HIV/AIDS, held in Rio de Janeiro from 4 to 5 November 2000, along with the final recommendations of that meeting. The report focuses on the diversity of the global HIV/AIDS pandemic, a diversity that is particularly evident in Latin America and the Caribbean. After providing an overall perspective on the epidemic in the Americas, the report describes the epidemic in different areas of the Americas: the Andean Subregion, Brazil, the Caribbean, Central America, Mexico, the Southern Cone, and North America. The problem of infections associated with HIV/AIDS is also addressed, especially tuberculosis, as well as other sexually transmitted infections. Also analyzed are achievements and challenges in preventing HIV infection, both in groups that are usually considered of low risk (heterosexual adults) and those of high risk (men who have sex with men, intravenous drug users, young people, and marginalized populations). Other aspects analyzed are efforts to improve HIV surveillance, new antiretroviral agents and their impact, and the prevention of vertical transmission of HIV.